Annex-II FORMAT FOR PRELIMINARY ASSESSMENT OF TOTAL ENERGY CONSUMPTION IN THE UNIT Name of the Unit Complete address

of the Unit along with Telephone No., Fax No. & Email Name and Telephone of contact person at the Unit A. Power and Fuel Consumption (Please provide Unit data) Current Year 1. Electricity (a) Purchased Units (lakh kWh) (b) Own Generation (i) Through diesel generator Units (lakh kWh) Units per litre of diesel oil (ii) Through steam turbine/generator Units (lakh kWh) Units per litre of Fuel Oil /Gas/Solid Fuel (iii) Through Gas turbine/generator Units (lakh kWh) Units per litre of Fuel Oil / Gas (iv) Any other sources such as wind, renewables etc. Units(lakh kWh) * Coal/lignite/other solid fuels (specify quality and where used) Quantity (tones) Gross calorific value * Furnace Oil/LSHS/HSHS/HSD/LDO Quantity (kilolitres) Gross calorific value * Gaseous fuels (CNG/LPG) Quantity (SCM)/tones Gross calorific value * Others/internal generation (please give details) Quantity Gross calorific value * Fuel Consumption may be given which is used for process not for power generation. In case, if fuel is used as a raw material, it will not be considered as an input energy. Previous Year

Annex-V

Mandatory Information to be submitted by Designated Consumers on the Appointment or Designation of Certified Energy Manager
Name of the Sector Name of Plant (State / UT) Complete Postal Address of the plant including :a) Chief Executives Name b) Mobile No. c) Telephone No. with STD code d) Fax No. with STD code e) Email address Annual Energy Consumption of the plant in terms of Metric Tonne of Oil Equivalent (MTOE) Name of the Certified Energy Manager with a) BEE Exam Registration No. b) Complete Postal address c) Mobile No. d) Telephone No. with STD Code e) Fax No. with STD Code & f) Email address

Signature of the Chief Executive Name & Designation of the Chief Executive Organization Seal..

Date: Place: Note: Attach self attested copy of certificate of certified Energy Manager